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   2020| March-April  | Volume 10 | Issue 2  
    Online since April 27, 2020

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How fluoride protects dental enamel from demineralization
James Patrick Simmer, Nina C. Hardy, Afriti F. Chinoy, John D. Bartlett, Jan C-C. Hu
March-April 2020, 10(2):134-141
Introduction: How fluoride (F) protects dental enamel from caries is here conveyed to dental health-care providers by making simplifying approximations that accurately convey the essential principles, without obscuring them in a myriad of qualifications. Materials and Methods: We approximate that dental enamel is composed of calcium hydroxyapatite (HAP), a sparingly soluble ionic solid with the chemical formula Ca10(PO4)6(OH)2. Results: The electrostatic forces binding ionic solids together are described by Coulomb’s law, which shows that attractions between opposite charges increase greatly as their separation decreases. Relatively large phosphate ions (PO43–) dominate the structure of HAP, which approximates a hexagonal close-packed structure. The smaller Ca2+ and OH ions fit into the small spaces (interstices) between phosphates, slightly expanding the close-packed structure. F ions are smaller than OH ions, so substituting F for OH allows packing the same number of ions into a smaller volume, increasing their forces of attraction. Dental decay results from tipping the solubility equilibrium Ca10(PO4)6(OH)2 (s) ⇔ 10Ca2+ (aq) + 6PO42– (aq) + 2OH (aq) toward dissolution. HAP dissolves when the product of its ion concentrations, [Ca2+]10×[PO43–]6×[OH]2, falls below the solubility product constant (Ksp) for HAP. Conclusion: Because of its more compact crystal structure, the Ksp for fluorapatite (FAP) is lower than the Ksp for HAP, so its ion product, [Ca2+]10×[PO43–]6×[F]2, must fall further before demineralization can occur. Lowering the pH of the fluid surrounding enamel greatly reduces [PO43–] (lowering the ion products of HAP and FAP equally), but [OH] falls much more rapidly than [F], so FAP better resists acid attack.
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Increasing immunity to fight against novel COVID-19: Noninvasive public health approach
Rushabh Jayeshbhai Dagli
March-April 2020, 10(2):125-126
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Chemopreventive agents in oral premalignancy: A medical management review
Chintada Suvarna, Nallan CSK Chaitanya, Shaik Ameer, Pavitra Inamdar, Swetha Alugubelli, Alakananda Bhagyanagar
March-April 2020, 10(2):127-133
Aims and Objective: The term chemoprevention denotes the use of specific natural or synthetic chemical agents to prevent carcinogenesis. Chemoprevention may help delay the process of carcinogen activation and prevent the conversion of preneoplastic cells. These agents play an active role in the secondary level of prevention and reduce malignancy-associated morbidity and mortality. A new term, “prophylactic antioxidant therapy,” was coined and proposed. This review has assessed all major chemopreventive agents used for oral premalignancy and malignant conditions, which will reduce the economic burden on the patients. Materials and Methods: A systematic literature search was performed using PubMed, Medline, Embase, Cochrane Library, and EBSCO search, with language restriction to English. The search incorporated published literature from 1990 to 2018 using the medical subject heading terms. Literature search was performed using the following keywords: Chemoprevention, Premalignancy, and Oral Malignancy. Results: Of 99 publications related to the search strategy, 45 full articles relevant to the chemopreventive agents in premalignacy and oral malignancy were acquired for further inspection. Of the 45 articles, 30 met the inclusion criteria. Data were collected, and a brief summary of the studies regarding different chemopreventive agents that were most commonly used in oral premalignancy and malignancies was written. Conclusion: This review suggests administration of major chemopreventive agents for superior prognosis in individuals with an elevated risk of premalignancy and malignancy.
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Dentists’ willingness to report suspected violence cases in Saudi Arabia
Mostafa A Abolfotouh, Hind A Alfehaid, Dalal S Almadi, Hadeel W Aldali, Asma A Alshareef, Abdullah A Adlan
March-April 2020, 10(2):220-225
Background and Aim: Violence is a life-threatening issue that mainly affects head and neck areas. Dentist might be the first person to notice this type of injury. This study aimed to investigate dentists’ willingness to report suspected violence exposure of their patients and factors associated with their willingness. Materials and Methods: In a cross-sectional study of 363 dentists in Riyadh, Saudi Arabia, a previously validated self-administered questionnaire was distributed, in both printed and electronic forms (Google Forms), to collect data on personal characteristics, professional background, and negative perception and professional attitude toward reporting suspected violence. Descriptive and analytic statistics were applied. Significance was considered at P ≤ 0.05. Results: The majority of dentists reported positive perception (88.4%) and positive attitude (68.0%) toward reporting suspected violence, with percentage mean scores of 35.2 ± 19.6 and 83.5 ± 15.0, respectively. Higher professional attitude score was significantly associated with the ability of dentists to recognize signs of violence (t = 3.19, P = 0.002). Negative perception mean scores were significantly higher with non-Saudi nationality (t = 2.03, P = 0.043), private sector (F = 3.33, P = 0.037), no training on abuse management (t = 3.02, P = 0.003), and perceived ability to identify victims of violence (t = 2.61, P = 0.01). After adjusting for potential confounders, negative perception was predicted by non-Saudi nationality (P = 0.028) and no history of previous training in abuse management (P = 0.004). Conclusion: Almost all dentists have high professional attitude scores and low negative perception scores toward reporting violence, which reflect a good sense of responsibility toward their patients and community. Educational training in abuse management must be a requirement for dental practice.
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Decoding the perplexing mystery of para-chloroaniline formation: A systematic review
Mohd. Sibghatullah Khatib, Bilal Ameer, Nikita Ajit Mannur, Amith Madi Ramalingaiahsetty, Sayed Mateen Peerzade, Amrut Bambawale
March-April 2020, 10(2):142-147
Objective: The objective of this article was to understand and decode the mystery of the formation of para-chloroaniline (PCA). The ingredient of the brown precipitate after mixing sodium hypochlorite (NaOCl) and chlorhexidine gluconate (CHX) is still in debate. Materials and Methods: Various studies adopt a different methodology to substantiate that it may contain PCA, which is a carcinogenic agent. The purpose of this systematic review is to evaluate the relationship between PCA and brown precipitate. Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies were manually searched. There was no disagreement between the two reviewers. This review was reported and conducted in step with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Of 233 articles, only 13 articles met the inclusion criteria. Available scientific evidence was more supportive that the brown precipitate form after mixing NaOCl and CHX may form para-chloroamide moiety rather than free PCA, and PCA may be the by-product of CHX degradation. Conclusion: On the basis of the current evidence and data extracted from the various databases, it can be concluded that the mixture of sodium hypochlorite and chlorhexidine does not form PCA, and PCA may be the by-product of high concentrated chlorhexidine. Further studies are required to substantiate the evidence.
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Irradiance of different curing modes of common light cure devices: An in vitro study
Hani M Nassar, Mahmoud Almutairi, Albaraa Makhdom
March-April 2020, 10(2):177-182
Aim: The aim of this study was to test the irradiance values of different curing modes of commonly available light cure devices (LCDs). Materials and Methods: An in vitro investigation was carried out to compare the irradiance output of 10 brands of LCDs available in Saudi Arabia measured using a digital radiometer. Values were recorded for three time points when applicable (0, 10, and 20s). This technique was repeated five times for each LCD. Normal, high-intensity, and soft-start modes were evaluated for all brands with the features available. Irradiance values between brands were analyzed using one-way analysis of variance followed by Bonferroni method. Changes in irradiance between different time points were analyzed using one sample t test for normal and high-intensity modes and using paired t test for soft-start mode. All comparisons were carried out at 0.05 significance level. Results: The highest values were reported for Ortholux Luminous, Elipar DeepCure-S, Elipar DeepCure, and KaVo mini-LED with values above 1000 mW/cm2. All LCDs showed values above 600 mW/cm2. Three LCDs had high-intensity mode and only one device had soft-start mode. Changes over the different time points were not statistically significant exept for soft-start mode. Conclusion: All tested LCDs had irradiance values sufficient for adequate polymerization of resin composite. Only four of these are capable of curing bulk-fill composites.
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Erratum: The effectiveness of micro-osteoperforations during canine retraction: A three-dimensional randomized clinical trial

March-April 2020, 10(2):235-235
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Inheritance and susceptibility to dental caries: A community-based study
Saima Y Khan
March-April 2020, 10(2):148-155
Background: Effects of consanguineous marriage on human population are known. However, the inherited susceptibility to dental caries is unfortunately quite limited. Aim: This study aimed to assess the dental caries status (DMFT/deft [decayed-missed-filling teeth/decayed-extracted-filled teeth] index) in children born out of consanguineous and non-consanguineous marriages. Design: Household survey using a cross-sectional study design was planned, with a sample size of 2000 comprising (1600 non-consanguineous and 400 consanguineous) children, aged 6–9 years. Household survey was also planned using a systematic random sampling. Researcher conducted the study by visiting every 10th household of every 10th ward of Aligarh city, Uttar Pradesh, India. Information of risk factors for dental caries (sociodemographic, birth order, oral hygiene, feeding practices) was recorded on a pretested questionnaire with clinical examination of DMFT/deft index. Analysis: Student t test for equality of means and multivariate logistic regression were used. Results: By Student t test for equality of means, D component (P = 0.003), d component (P < 0.001), and deft score (P < 0.001) were statistically significant in the consanguineous group. Multivariate logistic regression did not deduce any association of either of the study groups, but a significant association of risk factors with dental caries was observed. Conclusion: Dental caries that has multifactorial etiology, both environment and genetic factors, had an influence on the causation of dental caries in this study.
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Fracture resistance of endodontically treated maxillary premolars with a longer single post and shorter double posts of different sizes: An in vitro study
Arun Mayya, Rajaram Naik, Shreemathi S Mayya, Maria P Paul
March-April 2020, 10(2):183-188
Aim: The aim of this study was to determine if there is any difference in fracture resistance between different post sizes and lengths when more than one post is involved. Materials and Methods: Thirty extracted maxillary first premolars were endodontically treated and divided into three groups: In Group 1 (control group), no post space preparation was conducted and access cavities were restored with composite; in Group 2 (single post), post space preparation of 10mm was carried out only in one of the canals; and in Group 3 (double post), post space preparation of 5mm was conducted in both the canals. Appropriately sized glass fiber posts were cemented in Groups 2 and 3 followed by core buildup. The fracture resistance of the specimen was measured using a universal testing machine and the data analyzed. The mean fracture resistance values of the three groups were compared applying one-way analysis of variance (ANOVA) followed by post hoc Tukey’s test. The data were analyzed using Statistical Package for the Social Sciences software program, version 15.0. South Asia, Bangalore. Results: The control group had a significantly lower fracture resistance value as compared to Groups 2 and 3. No statistically significant difference was observed in the fracture resistance between Groups 2 and 3. Conclusions: No significant difference was observed between the fracture resistance of endodontically treated maxillary first premolars restored with size 3 single post of longer length and size 1 double posts of shorter lengths.
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The Impact of Lifestyles on Dental Caries of Adult Patients in Udupi District: A Cross-Sectional Study
Nishu Singla, Shashidhar Acharya, Ritesh Singla, Prajna Nayak
March-April 2020, 10(2):189-195
Background: Dental caries is preventable if favorable health behavior is successfully established. Exploring the broader concept of lifestyle will be useful to determine that how lifestyle of people can affect dental caries. Aim: The aim of this study was to determine the impact of overall lifestyle of an individual (analyzed using health practice index) on dental caries of adult population. Material and Methods: This cross-sectional study comprising structured questions on health practice index, sociodemographic variables, and oral health-related behavior was conducted on 800 study subjects of age 20–50 years attending outreach dental setups of a dental school in India. Dental caries was recorded with decayed, missing, and filled teeth (DMFT) index. Statistical analysis was carried out using frequency distribution for variables related to lifestyle, mean ± standard deviation for DMFT, and negative binomial regression to predict a dependent variable (DMFT) that consisted of “count data.”Results: The study subjects who were older age, women, unemployed, and unskilled; those with lower education, lesser income, and lower socioeconomic status; those never visited dentist; and those with lesser frequency of cleaning teeth, overall poorer lifestyles, and moderate lifestyles were more prone to have dental caries than their counterparts. Conclusion: Dental caries is a multifactorial disease. Patients’ involvement in self-care by promoting healthy behaviors such as brushing twice a day, visiting dentist regularly, negating orally abusive substance addiction, having breakfast every day, eating a balanced diet, and reducing stress leads to an overall good lifestyle. These factors along with sleeping a minimum of 7–8h per night and working for 8–9h per day and ample daily exercise may help patients improve or protect their oral health for years to come.
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Evaluation and comparison of caries excavation efficacy of three different burs: A micro-computed tomographic-assisted study
Vinay Vusurumarthi, Srinidhi V Ballullaya, Shankarappa Pushpa, Venkata Ramya K Veluvarti, Pramod R Loka, Pavan K Galla
March-April 2020, 10(2):213-219
Aims and Objectives: The aim of this study was to evaluate the effectiveness of three different caries excavation methods using micro-computed tomography (micro-CT). Materials and Methods: Fifteen freshly extracted human molar teeth with occlusal dentinal caries were selected. The teeth were sectioned longitudinally into two halves and were randomly divided into three groups (n = 10) depending on the caries removal technique: Group 1: tungsten carbide (TC) bur, Group 2: cerabur (CB), and Group 3: Excavus (EX) tipEX). A preoperative micro-CT scan of all the samples was taken. The caries excavation procedures were carried out followed by postoperative micro-CT scan. The preoperative and postoperative scans of each tooth were analyzed for caries removal effectiveness (CRE), mineral density (MD), and minimal invasiveness potential (MIP) using Avizo 9.4 software (Thermo Fisher Scientific, Germany). Statistical analysis was conducted by applying three-way analysis of variance and independent sample t-test using the Statistical Package for the Social Sciences software, version 20.0 (IBM Corporation, USA). Results: Among the three groups, the TC group had the smallest RC/IC (residual caries/initial caries) ratio, highest mean MD at the cavity floor, and highest MIP. The EX group significantly had the highest RC/IC, lowest mean MD, and lowest MIP. Both the CRE and MIP parameters of CB group were acceptable (RC/IC = 0.08, mean MD = 1.09g/cm3, and MIP = 1.09). Conclusion: As compared with the three excavation methods, CBs can be considered as an alternative to TC burs because of its MIP and complete removal of infected carious dentin.
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Evaluation of Microflora (Viral and Bacterial) in Subgingival and Placental Samples of Pregnant Women with Preeclampsia with and without Periodontal Disease: A Cross-Sectional Study
Swetha Tanneeru, Jaideep Mahendra, Mahaboob Vali Shaik
March-April 2020, 10(2):171-176
Aim: Previous studies showed associated periodontal disease with various systemic ailments. This research work was aimed at studying the presence and role of periodontal microflora on preeclampsia during pregnancy. Materials and Methods: A cross-sectional study was designed on pregnant women with preeclampsia with and without chronic periodontitis, attending Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India, for prenatal checkups. After obtaining consents, 445 women were recruited in the study. On the basis of systemic and periodontal health, subjects were grouped into Group 1 (women with preeclampsia with chronic periodontitis) and Group 2 (women with preeclampsia without chronic periodontitis). Clinical parameters such as plaque index, bleeding on probing, probing depth, and clinical attachment level were recorded. Quantification of periodontopathic bacteria (Porphyromonas gingivalis, Fusobacterium nucleatum, Prevotella intermedia, Tannerella forsythia, Treponema denticola), Epstein–Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV), were detected using real-time polymerase chain reaction in subgingival samples at one point of time and later compared in placental tissue after parturition. Results: T. forsythia, T. denticola, F. nucleatum, P. intermedia, EBV, CMV, and HSV were expressed more in Group 3 compared to those in Groups 2, 4, and 1, in their subgingival and placental samples. Conclusion: Elevated levels of bacteria and viruses were expressed in subgingival and placental samples in women with preeclampsia with chronic periodontitis compared to those in women with preeclampsia without chronic periodontitis. This shows that chronic periodontitis is a risk factor for preeclampsia. The results concluded that periodontal flora is not only localized to periodontal tissues but can also enter uterine cavity and may elicit their pathological response on mother and developing fetus.
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Effect of core materials on the dimensional accuracy of casts made of two different silicone impression materials: An experimental study
Mitra Farzin, Reza Derafshi, Rashin Giti, Mohammad-Hassan Kalantari
March-April 2020, 10(2):196-204
Background and Aim: Dimensional accuracy of impressions is crucial to the quality of fixed restorations. This accuracy can be highly affected by the type of core and impression materials. This study aimed to assess the effect of different core materials on dimensional accuracy of two silicone impression materials. Materials and Methods: In this in vitro study, three master core models were fabricated of amalgam, composite resin, and nickel–chromium. Of each model, 30 impressions were taken; 15 with additional and 15 with condensational silicone impression material. The accuracy of impressions of the three core materials was assessed by measuring two linear dimensions and one vertical dimension on the stone casts. Statistical Analysis: Data were analyzed with two-way analysis of variance and Scheffe post hoc test (α = 0.05). Results: Accuracy of the three measured dimensions was significantly affected by both the impression and core materials (P < 0.05). Additional silicone was significantly more accurate in linear dimensions, and impressions of the amalgam core were significantly more accurate than other cores in linear dimensions. Conclusion: Additional silicone impression material had more detail reproduction, and the impressions of amalgam core were more accurate than the composite and nickel–chromium core materials.
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Oral health status of schoolchildren living in remote rural Andean communities: A cross-sectional study
Dave A Bergeron, Lise R Talbot, Isabelle Gaboury
March-April 2020, 10(2):156-162
Objective: Oral health promotion (OHP) was introduced in Peruvian primary schools in 2013, and no evaluation has been undertaken in rural areas since then. To measure OHP outcomes, this cross-sectional study aimed to assess the oral health (OH) status of schoolchildren living in a remote rural area of the Cusco region. Materials and methods: Sixty-six children were recruited in three remote rural communities and in a rural district capital. Six dimensions of OH (knowledge, attitudes, behaviors, dental plaque, dental caries, and quality of life related to OH) were measured using self-administered questionnaires and dental examinations. Wilcoxon–Mann–Whitney tests were conducted to compare outcomes between two types of settings (remote rural community and district capital). Multiple linear regression models were fit to identify which variables can explain the variance observed in the decayed, missing, and filled teeth (DMFT) index. Results: The median percentage of dental plaque in remote rural communities was 78.7% (interquartile range [IQR] 71.5–82.8) and 78.6% (IQR 72.7–82.2) in the district capital (P = 0.90). The prevalence of dental caries was estimated to be 94.1% (95% confidence interval [CI] 71.1–>99.9) in the district capital and 98.0% (95% CI 88.3–>99.9) in remote rural communities (P = 0.43). Conclusion: These results suggested that OHP interventions had not reached their full potential. Identifying different factors that influence the reported outcomes would provide a more comprehensive understanding and help to tailor OHP interventions.
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Evaluating the color stability of ocular prosthesis after immersion in three different immersion media: An in vitro study
Seema Sathe Kambala, Deepika Rathi, Anjali Borle, K Rajanikanth, Tanvi Jaiswal, Mithilesh Dhamande
March-April 2020, 10(2):226-234
Background: Immersion media such as ophthalmic irrigation solution, eye lubricant solution, and neutral soap solution will be the best, which will help in the longevity as well as the color stability of ocular prostheses. Aim: The aim of this study was to evaluate and compare color stability of ocular prosthesis after immersion in three different immersion media. Materials and Methods: A total of 90 samples of scleral acrylic resin were prepared, which were painted with natural dry earth pigment NEAS and then were divided into three groups. These samples were checked before and after immersion in respective media after 8 weeks. To assess the color change, a spectrophotometry test was performed and the results were statistically analyzed by one-way analysis of variance and post hoc Tukey’s test. Results: Among all the three groups, the samples immersed in neutral soap solution proved to be most color stable, followed by eye lubricant solution, and the least color stable among the three was ophthalmic irrigating solution. Conclusion: The neutral soap solution proved to be the most color stable.
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Erratum: A Preexperimental Study to Assess the Impact of an Interdisciplinary Educational Intervention on Nurses' Knowledge of Perinatal and Infant Oral Health Care

March-April 2020, 10(2):236-236
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The impact of dental environment stress on dentition status, salivary nitric oxide and flow rate
Raghad Ibrahim Kadhum Al-Moosawi, Alhan Ahmed Qasim
March-April 2020, 10(2):163-170
Aim: This study aimed to assess the dental caries experience among dental students with different levels of dental environment stress in relation to salivary nitric oxide (NO) and flow rate of whole unstimulated saliva. Materials and Methods: The study involved 300 dental students. They were classified into three categories (mild stress, moderate stress, and severe stress) according to dental environment stress questionnaire (DESQ); clinical examination for dental caries was carried out. Unstimulated salivary samples were collected from the mild and severe stress groups for measuring the salivary flow rate. Estimation of salivary NO was carried out by using salivary NO test strips. All data were analyzed using the Statistical Package for the Social Sciences software, version 21.0 (SPSS, Chicago, Illinois). Results: Dental caries experience was higher among severe and moderate stress groups with nonsignificant differences (P > 0.05). Mean value of salivary flow rate was lower among severe stress group with nonsignificant differences (P > 0.05). NO was significantly higher among severe stress group (P < 0.05). Flow rate was weak negatively correlated with caries experience among both mild and severe stress groups except for the decay surface (DS), which was weak positive among mild stress group. NO was weak negatively correlated with DS among both mild and severe stress groups. All these correlations were statistically not significant (P > 0.05). Conclusion: Dental environment stress appears to affect oral health, shown by higher dental caries among dental students with severe dental environment stress by affecting the normal level of salivary flow rate and NO.
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Morphological and chemical alterations of root surface after Er:Yag laser, Nd:Yag laser irradiation: A scanning electron microscopic and infrared spectroscopy study
R Karthikeyan, Pradeep Kumar Yadalam, AJ Anand, Kamalakannan Padmanabhan, G Sivaram
March-April 2020, 10(2):205-212
Aims and Objectives: This study aimed to evaluate the efficacy of Nd:YAG and Er:YAG lasers in removing the smear layer and to study the morphological and chemical alterations of the root surface using scanning electron microscopy (SEM) and infrared (IR) spectroscopy. Material and Methods: Fifty-five extracted upper incisor teeth were collected and 110 specimens of size 3 mm × 4 mm × 1 mm were prepared. For SEM evaluation, these samples were divided into six groups: A, B, and C. Group A comprised five samples that served as control. Groups B and C were further divided into five subgroups and each subgroup comprised five samples. All the specimens within the subgroups of B and C irradiated with 100, 200, 300, 400, and 500 mJ of Er:YAG laser and 211.66, 423.33, 635, 846.66, and 1058.33 J/cm2 of Nd:YAG laser, respectively. The morphological changes of the laser-treated sites were observed qualitatively using an arbitrary scale under SEM. The data obtained were statistically analyzed by one-way analysis of variance (ANOVA) multiple range test by Turkey’s honestly significant difference and Mann–Whitney U test. In chemical structural changes, Group D comprised five samples that served as nonirradiated control and Groups E and F were irradiated with the same aforementioned parameter and evaluated using Fourier-transform infrared spectroscopy. Results: Er:YAG laser at 100 mJ effectively removed smear layer without any crater formation. The Nd:YAG laser removed the smear layer at the energy density of 211.66 J/cm2 and 423.33J/cm2. The energy density of 1058.33 J/cm2 showed visible charring and deep crater with increased area of melted and resolidified minerals in SEM. In the chemical changes, IR spectroscopy graph showed the reduction in peak intensity beyond 846.66 J/cm2 of and new absorption band was noticed (2010cm–1 and 2017cm–1) at samples treated with 846.66 and 1058.33 J/cm2 of Nd:YAG laser. Conclusion: Er:YAG laser at lower energy density effectively removed smear layer without production of toxic substance as compared with Nd:YAG laser. Thus, Er:YAG laser can be used as an effective root biomodification agent.
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